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11 – 20 of over 1000
Article
Publication date: 4 February 2014

Emma Williams, Martha Ferrito and James Tapp

The efficacy of cognitive-behavioural therapy (CBT) for schizophrenia in community and general psychiatric settings has been widely investigated and its practice recommended in…

1692

Abstract

Purpose

The efficacy of cognitive-behavioural therapy (CBT) for schizophrenia in community and general psychiatric settings has been widely investigated and its practice recommended in primary and secondary care. In secure forensic mental health services the evidence is less established. The purpose of this paper is to evaluate the effectiveness of group CBT for schizophrenia in a high secure hospital.

Design/methodology/approach

In all, 27 male forensic patients completed a manualised CBT group and were compared on primary and secondary outcomes to patients receiving treatment as usual (TAU). Primary outcomes were positive and negative symptoms as measured by the Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS) and the Psychotic Symptom Rating Scales (PSYRATS). A secondary outcome was interpersonal functioning as measured by the Inventory of Interpersonal Problems (IIP-64).

Findings

CBT participants showed improvement on negative symptoms; affective flattening, alogia, anhedonia and avolition; in comparison to participants in TAU. CBT participants also showed reductions in delusions and hallucinations on the SAPS but not the PSYRATS. TAU participants improved on positive symptoms as measured by the PSYRATS. CBT participants showed reductions in overall interpersonal problems, and most notably in being socially inhibited and self-sacrificing. No iatrogenic effects of treatment were found; improvements in depression anxiety and stress were reported by group completers, which contrasted to experiences of the TAU group.

Research limitations/implications

Absence of random allocation to CBP or TAU groups retains the risk of recruitment bias. Findings are preliminary given the sample size. Multiple outcome assessments increase risk of a type I error.

Practical implications

CBT for schizophrenia can be effective with clients in secure forensic mental health settings. Improvements in negative symptoms and interpersonal functioning appear to be particular gains. Self-report measures might be subject to specific demand characteristics in such settings.

Originality/value

The evaluation includes a comparator group in a high secure setting, which is typically absent in reported evidence for this population (Blackburn, 2004). The study also investigated changes in interpersonal functioning, which has previously been noted as an important but absent outcome in CBT for psychosis (Haddock et al., 2009). Iatrogenic outcomes were also considered in the evaluation to ensure no adverse effects were experienced from treatment.

Details

Journal of Forensic Practice, vol. 16 no. 1
Type: Research Article
ISSN: 2050-8794

Keywords

Article
Publication date: 1 September 2006

Erica Mclnnis, William Sellwood and Clair Jones

This study reports a recovery‐themed cognitive behavioural educational group for clients suffering from chronic positive and negative symptoms of schizophrenia, on a low secure…

Abstract

This study reports a recovery‐themed cognitive behavioural educational group for clients suffering from chronic positive and negative symptoms of schizophrenia, on a low secure inpatient unit. Nine participants completed baseline and post‐intervention measures of insight, self‐esteem and knowledge about schizophrenia. Additional post‐intervention measures included compliance with medication, feelings about schizophrenia, qualitative views and access to the community. Overall, the results were positive within the limits of this small‐scale study. Following the intervention, most participants reported that they were less frightened about psychosis, and felt more in control of their illness and more optimistic about their future. This study suggests that there may be clinical benefits of having CBT‐orientated educational groups in low secure settings with clients with longstanding co‐existing positive and negative symptoms of schizophrenia. Recovery style should be evaluated systematically in future studies.

Details

The British Journal of Forensic Practice, vol. 8 no. 3
Type: Research Article
ISSN: 1463-6646

Keywords

Article
Publication date: 1 August 2006

Aileen Fraser

As a practitioner working in the field of adult protection I became aware that, although the responses to reports of abuse have become more effective and consistent, access to…

Abstract

As a practitioner working in the field of adult protection I became aware that, although the responses to reports of abuse have become more effective and consistent, access to treatment or therapy is limited. I therefore decided to explore the idea of using psychological approaches as interventions. My background is as a registered nurse and CAT (cognitive analytical therapy) practitioner. From some limited experience I have found that CAT can be a successful approach. In the course of this article I will examine the background to adult protection work in the UK, focusing on elder abuse, including self‐neglect, in domiciliary settings, to show the need to explore new approaches to treatment for both those who have been abused and those who are in the position of abuser. A selection of psychological therapies are explored to determine their potential to offer support for this group and the article concludes with examples of the use of CAT with adult protection referrals and a summary of the benefits and obstacles to this approach.

Details

The Journal of Adult Protection, vol. 8 no. 2
Type: Research Article
ISSN: 1466-8203

Keywords

Article
Publication date: 8 June 2015

Jane L. Ireland and Elisabeth Hansen

The purpose of this paper is to provide some practice considerations for working with personality disorder, focusing on the application of assessment, formulation and therapy to…

Abstract

Purpose

The purpose of this paper is to provide some practice considerations for working with personality disorder, focusing on the application of assessment, formulation and therapy to complex populations such as forensic clients. In addressing this it outlines the concept of a Multi-Modal Integrated Therapy (MMIT) and how this is applied to personality disorder intervention.

Design/methodology/approach

The core elements to consider in the provision of an integrated approach are outlined, informed by a review of the relevant literature. The paper does not aim to provide evaluation data but is intended to be a clinical practice document.

Findings

The value of integrating the effective components of therapy to address all aspects of working with forensic populations is evidenced. It is argued that appropriate approaches will capture cognitive components (including Early Maladaptive Schemas and also adaptive schemas), Cognitive Analytic Therapeutic approaches and Dialectical Behaviour Therapy components to produce an effective framework to capture the complexities of personality disorder in forensic populations.

Practical implications

The paper outlines how a move away from focusing on a single approach to understanding and intervening with personality disorder is key with complex populations, such as those found within forensic settings. The authors argue that practitioners should focus routinely on the importance of integration of principles relevant to personality disorder work.

Originality/value

The paper argues for: Adopting a truly multi-modal integrated approach to interventions with personality disorder, highlighting the importance of MMIT. The importance of accounting for complexity in personality presentation in forensic populations and capturing positive as well as negative functioning. The value in identifying what is effective within existing therapies and applying these components as part of a wider package. The core elements of an effective approach are indicated.

Details

Journal of Criminological Research, Policy and Practice, vol. 1 no. 2
Type: Research Article
ISSN: 2056-3841

Keywords

Article
Publication date: 22 April 2022

Tomasz Prusiński

The results of empirical research on the patient–psychotherapist relationship have led to the fundamental conclusion that the therapeutic alliance is one of the key factors…

Abstract

Purpose

The results of empirical research on the patient–psychotherapist relationship have led to the fundamental conclusion that the therapeutic alliance is one of the key factors ensuring the positive outcomes of psychotherapy. The main aim of the present study is to determine what variables pertaining to the context of psychotherapy (type of treatment applied in accordance with the psychotherapist’s modality/orientation, type of disorder diagnosed in the patient) differentiated the alliance.

Design/methodology/approach

Participants for the main study were recruited from public and private psychotherapy offices across Poland. The working alliance was assessed based on 262 psychotherapist–patient dyads. The sample consisted of 428 participants. To assess the quality of therapeutic alliance, the author used the full version of the Working Alliance Inventory as adapted into Polish.

Findings

The results of analyses led to several basic conclusions. The study revealed a differentiating effect of type of psychotherapy on the quality of therapeutic alliance. Alliance quality was not differentiated by the type of disorder diagnosed in patients and treated in the psychotherapeutic process.

Originality/value

The results of analyses presented in this empirical study allowed for exploring the quality of the therapeutic alliance with contextual variables related to the psychotherapeutic process taken into account.

Article
Publication date: 16 November 2012

Jon Taylor and Catrin Morrissey

The purpose of this paper is to provide an overview of the rationale for appropriate treatment for offenders with personality disorder and intellectual disability co‐morbid with…

Abstract

Purpose

The purpose of this paper is to provide an overview of the rationale for appropriate treatment for offenders with personality disorder and intellectual disability co‐morbid with intellectual disability (ID), and to describe a specific treatment model.

Design/methodology/approach

The paper provides a narrative review of approaches to treatment for offenders with personality disorder and draws on the available research for the treatment of personality disordered offenders without ID as well as the treatment of offenders with ID.

Findings

The relevance and validity of the construct of personality disorder in intellectual disability is reviewed. Evidence from treatment of personality disorder in mainstream populations is summarized. A treatment model, which integrates adapted cognitive behavioural programmes with a social milieu approach, is then described. It is argued that this treatment model addresses the criminogenic, psychological and social needs of those with personality disorder and intellectual disability.

Practical implications

Services being developed for people with both intellectual disability and personality disorder should take account of the literature on treatment of mainstream personality disorder when developing treatment models.

Originality/value

There are few published papers concerning treatment approaches with offenders with intellectual disability and personality disorder. This descriptive paper will be of interest to clinicians working with such populations.

Details

The British Journal of Forensic Practice, vol. 14 no. 4
Type: Research Article
ISSN: 1463-6646

Keywords

Book part
Publication date: 9 February 2023

Jeb Brown, Ashley Simon and Justin Turner

The use of data in the twenty-first century to improve expert decision-making has radically transformed what it means to be an expert in multiple fields, including behavioural…

Abstract

The use of data in the twenty-first century to improve expert decision-making has radically transformed what it means to be an expert in multiple fields, including behavioural healthcare. This chapter summarises the impact on information technology on the field, including use of digital platforms to enable video therapy and online cognitive behavioural therapy programmes. The chapter is intended for practitioners seeking information on how to be a twenty-first century expert, where years of education and experience matter less compared to evidence of performance in the form of solid outcome data. Key to the use of outcome data is expertise in how to use questionnaires in therapy and how to interpret results, both at the individual client level as well as overall results across multiple clients. A twenty-first century expert measures are not simply to measure outcomes but to improve results over time. Failure to incorporate the use of data into routine practice ignores an evidence based practice with decades of evidence as to its effectiveness, potentially resulting in suboptimal care.

Details

Evidence Based Counselling & Psychotherapy for the 21st Century Practitioner
Type: Book
ISBN: 978-1-80455-733-4

Keywords

Article
Publication date: 25 February 2014

Jesse Wynn, Aaron Hudyma, Elizabeth Hauptman, Tiffani Nicole Houston and James Michael Faragher

– The purpose of this paper is to seek to present an overview of past, present, and future approaches to the treatment of problem gambling.

Abstract

Purpose

The purpose of this paper is to seek to present an overview of past, present, and future approaches to the treatment of problem gambling.

Design/methodology/approach

This paper reviews the literature concerning conceptual, historical, and clinical research perspectives on the treatment of problem gambling.

Findings

Perspectives on the etiology, maintenance, conceptualization, and treatment of problem gambling have evolved over time. Once seen as a failure of moral character, problem gambling is now considered to be an addictive disorder with similarities to substance abuse disorders. Empirical research into the treatment of problem gambling is progressing, but is relatively sparse compared to the body of research in other addictive disorders. Methodological issues have been identified that will need to be addressed in future research. Currently, cognitive-behavioral approaches have received the most attention and have the greatest amount of research support. Brief interventions, pharmacological interventions, family therapy, and Gamblers Anonymous are also in use. Future directions for problem gambling treatment that are being researched and implemented are mindfulness-based interventions and internet-based treatment approaches.

Originality/value

This review should be useful to those seeking general information about problem gambling treatment, its development, status, and future directions.

Details

Drugs and Alcohol Today, vol. 14 no. 1
Type: Research Article
ISSN: 1745-9265

Keywords

Article
Publication date: 1 May 2005

Clive Long and Kelly Jones

Although smoking is a major health problem among forensic psychiatric inpatient populations, a multitude of factors (motivational, environmental, procedural and psychiatric…

Abstract

Although smoking is a major health problem among forensic psychiatric inpatient populations, a multitude of factors (motivational, environmental, procedural and psychiatric) militate against effective treatment. Despite this, few studies have reported on the use of population‐appropriate treatment approaches. This pilot study reports the results of group and individual treatments involving combination nicotine replacement therapy (NRT), motivational enhancement therapy (MET) and cognitive behavioural treatment. The importance of selecting patients with some skills in emotional regulation is highlighted, along with ways of reducing institutional obstacles to change and maximising environmental support for quit attempts.

Details

The British Journal of Forensic Practice, vol. 7 no. 2
Type: Research Article
ISSN: 1463-6646

Article
Publication date: 18 May 2012

Caroline J. Easton

This study aims to evaluate differences between substance dependent men who were arrested for intimate partner violence (IPV) with and without concurrent psychiatric problems.

329

Abstract

Purpose

This study aims to evaluate differences between substance dependent men who were arrested for intimate partner violence (IPV) with and without concurrent psychiatric problems.

Design/methodology/approach

In total, 63 participants were randomly assigned to manual‐guided group behavioral therapies (cognitive behavioral therapy for substance dependent domestic violence offenders (SADV) or drug counseling (DC)) and assessed across 12 weeks of treatment.

Findings

Despite excluding psychotic disorders and bipolar disorders at baseline, 23 percent of clients reported prior mental health treatment. SADV participants with co‐occurring mental health were different than SADV participants without co‐occurring mental health symptoms on both baseline and post‐treatment time periods. SADV participants with co‐occurring mental health symptoms had more pre‐treatment impairments, more drug use during treatment, a trend for more problems with aggressive behaviors throughout treatment and significantly more impairments in anger control subscales at post treatment compared to SADV participants without co‐occurring mental health symptoms.

Practical implications

The findings suggest the need to target and treat co‐occurring psychiatric symptoms and distress among SADV offenders. Perhaps offering clients targeted behavioral or pharmacotherapy adjunctive treatments can help improve treatment outcomes among substance dependent offenders of IPV when mental health problems are present.

Originality/value

This study is one of the first to evaluate differences between substance dependent men arrested for IPV with and without concurrent psychiatric problems. It shows that men who are violent toward their partners tend to have a co‐occurring problem with addiction, yet little is known about differences between substance dependent male offenders who have dual mental health problems.

11 – 20 of over 1000